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| |  Anticoagulant Therapy Increases Risk of Death After Haemorrhagic Stroke: Presented at ANA By Crina Frincu-Mallos, PhD BALTIMORE, Md -- October 20, 2009 -- Patients on anticoagulants have an increased risk of mortality 1 week after a haemorrhagic stroke, despite having haemorrhage volumes similar to patients who did not receive anticoagulant therapy, according to a study presented here at the American Neurological Association (ANA) 134th Annual Meeting. Anticoagulants and antiplatelets are the most prescribed drugs in North America, said Anunaya Jain, MD, University of Rochester, Rochester, New York, who presented the study here on October 12. Dr. Jain noted that intracerebral haemorrhage due to anticoagulants was first reported in 1984, and added that “prior studies have reported anticoagulants, as well as antiplatelets, to be independent risk factors for worse outcome.” The investigators sought a possible correlation between the use of anticoagulant and antiplatelet drugs and the severity of spontaneous nontraumatic intracerebral haemorrhage. They were also interested in evaluating the agents used for reversal of the haemorrhagic adverse events, and their effect on mortality and morbidity. A total of 245 adult patients, with a mean of 73 years of age (range 59 to 82 years), were included in this study between January 2006 and December 2008. All had been diagnosed with spontaneous intracerebral haemorrhage upon arrival in the emergency department. The majority of subjects were on antiplatelet therapy (32.6%), whereas 18.4% were using anticoagulants, and 8.9% were treated with both. Patients receiving anticoagulants were at a higher risk of having an intraventricular extension, compared with patients not receiving either therapy (1.43; 95% confidence interval [CI], 1.04 to 1.98; P = .035), Dr. Jain reported. “Twenty-nine percent of the patients died within 7 days of the intracerebral haemorrhage event,” said Dr. Jain. The international normalised ratio (INR), a measure of coagulation used to determine the clotting tendency of blood, was used to determine which patients were given reversal. The investigators reported that 52 of the 82 patients with INR 1.0 were given reversal (minimum INR 1.4, median 2.3). After receiving fresh frozen plasma, vitamin K, and/or recombinant factor VIIa, the median INR subsequent to reversal therapy decreased to 1.25 (range, 1 to 1.5). At 24 hours, the median INR normalised to 1.2 for the cohort (range, 1.1 to 1.3), Dr. Jain reported. Patients receiving anticoagulants had a relative risk of 1.74 (95% CI, 1.0 to 3.03) for mortality at 1 week, when compared with patients who did not use either therapy (P = .05). “The higher mortality could be secondary to higher odds of intraventricular extension,” speculated Dr. Jain. Interestingly, “no relationship was found between mortality and the use of antiplatelets or the combination [of] antiplatelets plus anticoagulants,” Dr. Jain noted. “Antiplatelet therapy has no bearing on death, volume, or intraventricular extension of the haemorrhage,” the investigators concluded.
[Presentation Title: Impact of Anti-coagulants and Anti-platelets on Outcomes Following Spontaneous Intra-cerebral Hemorrhage. Abstract M-26]
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